ABSTRACT
Objective To compare the clinical therapeutic effect of percutaneous nephrolithotomy (PCNL) and flexible ureteroscope lithotripsy (FUL) for unilateral lower-calyceal calculi with the diameter of 10-20 mm. Methods The clinical data of 65 patients with unilateral lower-calyceal calculi with the diameter of 10-20 mm were retrospectively analyzed. Thirty cases were treated with PCNL (PCNL group), and 35 cases were treated with FUL (FUL group). The operative time, success rate of lithotomy, haemoglobin decrease after operation, postoperative hospital stay, hospitalization expenses and complication were compared between 2 groups. Results Treatment was completed successfully in the patients of 2 groups, without ureteral perforation, avulsion and other serious complications intraoperatively and postoperatively. There were no statistical differences in success rate of lithotripsy, incidence of high fever after operation and postoperative analgesia rate between 2 groups (P>0.05). The operative time and hospitalization expenses in FUL group were significantly higher than those in PCNL group:(95.27 ± 22.69) min vs. (62.25 ± 20.73) min and (17 242 ± 2 679) yuan vs. (14 205 ± 1 654) yuan, and the haemoglobin decrease after operation and postoperative hospital stay time were significantly lower than those in PCNL group:(0.67 ± 0.33) g/L vs. (7.98 ± 4.33) g/L and (3.75 ± 0.78) d vs. (6.54 ± 1.68) d, and there were statistical differences (P<0.05). Conclusions For the treatment of lower-calyceal calculi with the diameter of 10-20 mm, the success rates of lithotripsy of PCNL and FUL are similar. FUL has less trauma, with shorter postoperative hospital stay time, but the cost is relatively high.
ABSTRACT
Objective To compare health related quality of life (HRQOL) between modified and traditional cutaneous ureterostomy, and explore the reasons for these differences, in order to provide the basis of HRQOL for the choice of cutaneous ureterostomy. Methods A total of 53 patients underwent cutaneous ureterostomy were selected, and the patients were divided into traditional cutaneous ureterostomy group (traditional group, 21 cases) and modified cutaneous ureterostomy group (modified group, 32 cases) according to the surgery method. The patients were evaluated by functional assessment of cancer therapy-bladder (FACT-BL), and the HRQOL was compared between 2 groups. Results There were no statistical differences in HRQOL score at 1, 3, 6 and 9 months after surgery between 2 groups (P>0.05). The HRQOL score at 12 months after surgery was significantly higher in modified group than that in traditional group:(141.5 ± 10.4) scores vs. (123.1 ± 5.2) scores, and there was statistical difference (P0.05). But the scores of functional status and bladder cancer special scale (BSS), total score of FACT-BL in modified group were significantly higher than those in traditional group:(26.0 ± 2.5) scores vs. (23.8 ± 3.5) scores, (46.7 ± 6.2) scores vs. (34.8 ± 5.5) scores, (143.9 ± 15.7) scores vs. (117.5 ± 8.1) scores, and there were statistical differences (P<0.01). Conclusions The HRQOL at 12 months after surgery in modified cutaneous ureterostomy is better than that in traditional cutaneous ureterostomy. Therefore, if the patient's physical condition permits, priority should be given to modified cutaneous ureterostomy to reduce the complications and improve the quality of life.
ABSTRACT
Objective To discuss the surgical treatment of contracted bladder caused by ketamine abuse. Methods Twenty-five ketamine male abusers were included in this study.The ages were from 19 to 28 years old and mean age was 24 years old.AIl of them had abused ketamine history for 0.7 tO 4.0 years,and presented with severe lower urinary tract symptoms.including severe frequency,urgency,urge incontinence,and painful haematuria.Urine cultures were negative.Hepatic function and renal function were normal.B ultrasound examination of 23 cases demonstrated the presence of bilateral hydronephrosis,the separation of renal pelvic was(1.8±0.7)cm.B ultrasound examination of 22 cases demonstrated residual urine was 45-1 50 ml,mean 80 m1.Twenty-three IVU investigations demonstrated the presence of bilateral hydronephrosis with calyces renales minores cycloidal expansion and bladder contraction.All the patients took the urodynamies with bladder capacity was (89±34)ml,end filling detrusor pressure was(48±26)cm H2O,Qmax was(7.8±2.3)ml/s,residual urine volume was(82±47)m1.All patients had cystoscopies and random biopsies performed showed ulcerative cystitis only.All patients were required to withdraw the narcotics and the experimental medicines were given without symptoms alleviated.Sigmoid cystoplasty was performed in all the 25 patients. Results The mean follow up was 18 months(rang 6 to 36).Compared with that before operation, bladder capacity increased to (375 ±53)ml, end filling detrusor pressure reduced to( 13 ±9)cm H2O, Qmax increased to(17.6±5.8)ml/s, residual urine volume reduced to(20±10)ml.Compared with the preoperative, there were statistically significant differences.There was no complained of urinary incontinence, enuresis, frequency, urgency.Urine routine examination was normal.IVU showed the vesicoureteral reflux disappeared in all patients, and calyces renales no expansion or calyces renales minores light degree expansion.B ultrasound examination that the separation of renal collecting was(1.0 ±0.5)cm. Conclusions Sigmoidcystoplasty could increase bladder capacity and compliance, lower the intravesieal pressure.It could improve the patients' quality of life.